Saturday, September 14, 2013

When I was a med student back in the UK, the subject I enjoyed most during the pre clinical years was anatomy. Going into the dissecting room with it’s chemical atmosphere of formalin and row upon row of benches with white sheeted cadavers certainly added a intriguing element to the whole thing. But the best, and most amazing part of anatomy for me was the embryology.
What happens in the first six weeks of human life is absolutely awesome: that short period of time after the male sperm penetrates the female egg and fusion occurs is truly mind bending. The single cell, formed as a result of this fusion, will then undergo a number of divisions to form a microscopic blob of cells: and within these cells a plate of cells form which will then undergo a series of twists, bends and folds and hey presto, by 6 weeks there is a recognizable human life with a tiny pumping heart circulating blood around this floating look-a-like spaceman. In fact, just about everything inside the body has been formed by the 6 weeks mark but the maturation process that is necessary to allow the embryo to become an independent human will take several months more, and some structures such as the human brain will continue to mature well into the late teens and early 20’s - which maybe helps explain to often exasperated parents why their teenagers can often appear to be on a different wavelength!
But back to pregnancy.
Put simply, pregnancy needs a male sperm to ascend into the uterus, find the egg in the fallopian tube and then penetrate it’s protective mucous barrier: in adult terms, this would be the equivalent of one of us running a marathon, wading through thick, glutinous jelly and then breaking into a bank vault. Some sperm can achieve this feat within 5 to 10 minutes whilst others may take up to 72 hours to reach the fallopian tube - but only one of the approximately 180 million sperm released with each ejaculation will fuse with the female egg. Interestingly, over the past 50 years the number of sperm per ejaculate has fallen by 50% and the number of healthy motile sperm has fallen too: but even of more interest is that fact that in those areas of the world with the least amount of pollution, the sperm count has not altered during the same period of time.
For her part, the female of the species will nearly always produce just one egg per cycle and this will survive for less than 48 hours before disintegrating. However, fertile mucus within the vagina that is produced just prior to ovulation can help nourish sperm and help them survive until the egg appears. All this means that there is only a narrow window of opportunity each menstrual cycle for a woman to become pregnant, and for many, “falling“ pregnant can be a difficult process. It is also thought that as many as 75% of all pregnancies will fail to continue past the early cell cluster stage, and without implantation, these cells will become a part of the next normal menstrual flow. But even those pregnancies that are confirmed early on with a pregnancy test, of those, 15 to 20% can miscarry too: so the message is, wait until after your missed period when the likelihood of a healthy pregnancy continuing to full term is much much higher, before you get a pregnancy test.
Preparing for pregnancy is just as important as caring for yourself during and after pregnancy. It’s a well known fact that if you eat a folate rich diet - think lots of green leafy vegetables and salads or a folate supplement - prior to pregnancy then the risk of neural tube defects such as spina bifida are greatly reduced. Spina bifida can vary from a very mild, assymptomatic defect in the bones of the lower spine to massive exposure of the nerves that control the bladder, lower bowel and the muscles of the legs. Eating your greens to help protect your hoped-for infant from such a life long physical disability, seems a pretty good idea to me, and it sets a great example for the rest of the family too!
The one principal I strongly promote at all ante natal visits is that “What’s good for Mum’s health is good for her child health too”: so no smoking, no alcohol in the first 12 weeks and just one glass if necessary to celebrate family occasions after that. Whatever you put in your mouth will probably end up in your baby’s body, so if you’re not sure what is best for you, then please do ask a professional who knows.
And on a practical level, every Mum who has been confirmed to be carrying a child needs to link up with a Medical practitioner. Your Family Doctor is the best link in this chain as he or she knows you and will continue to help you when the baby becomes an infant, and continue that care when your infant goes on to become a child at a school in your local community where your Family Doctors practice just happens to be too.
For a normal pregnancy you should be seeing a Doctor every 4 weeks until 30 weeks - assuming all is going well. After that it should be 2 weekly visits until 36 weeks and then weekly until the baby is born.
For many Mums, having a Specialist deliver their baby is important to them and your GP will arrange this: but the two of them can continue with “shared care” during the majority of your pregnancy - should all go smoothly - and that depends on you, your specialist and your GP. Others may go through the “Public” system but these shared care arrangements can still apply in these situations too, again depending on the wishes of the Mum, the Hospital Doctors and your usual GP. But he critical thing is that you should be seeing a Doctor on a regular basis because it is so important to pick up problems early and reduce the health risks to both babe and Mum.
At each visit you will be weighed, have your blood pressure and a urine sample checked: your tummy will be examined and the baby’s heart beat listened too. You need to report any changes in health and tell your Doctor of any medications or supplements that you might be taking, or if you are planing any overseas trips - all of this is normal routine, but it is very important and should never be ignored.
And because you change your shape and of necessity put on weight, pregnancy should not be a time when you ignore your fitness routine - it might have to be adapted, but never ignored. Being fit and healthy prior to pregnancy and during pregnancy will flow over into after pregnancy and help you regain your normal shape and lifestyle in the shortest period of time possible. Having seen the amazing effort that women exert during normal vaginal delivery, I stand in awe of their power and endurance.
Having a baby can be a bit like climbing Everest, but the benefits are glorious and they last a lifetime.image